Gonano C, Kettner S C, Ernstbrunner M, Schebesta K, Chiari A, Marhofer P
Department of Anaesthesia, Intensive Care Medicine and Pain Control, Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria.
Br J Anaesth. 2009 Sep;103(3):428-33. doi: 10.1093/bja/aep173. Epub 2009 Jul 8.
This study investigated the cost-effectiveness of ultrasonographic-guided interscalene brachial plexus blockade (ISB) in comparison with general anaesthesia (GA) for arthroscopic shoulder surgery.
Forty patients undergoing arthroscopic shoulder surgery received either an ultrasonographic-guided ISB or GA. ISB was performed outside the operation room (OR) and patients were transferred in the OR at the earliest 20 min after block performance. All drugs and disposables were recorded to evaluate the costs for both techniques. The following anaesthesia-related times were defined: ready for surgical preparation (from arrival in the OR until end of anaesthesia induction), OR emergence time (from end of dressing until leaving the OR), anaesthesia control time (from patient's arrival in the OR until readiness for positioning plus time from the end of surgery to patient's discharge from the OR), and post-anaesthesia care unit (PACU) time (from patient's arrival in the PACU to the eligibility for discharge to normal ward). Personnel costs were excluded from statistical analysis.
The total costs were [mean (sd)] 33 (9)euro for patients with ISB and 41 (7)euro for those who received GA (P<0.01). The anaesthesia-related workflow was improved in the ISB group when compared with the GA group [ready for surgical preparation 8 (3) vs 13 (5) min, P<0.001; OR emergence time 4 (3) vs 10 (5), P<0.001; anaesthesia control time 12 (4) vs 23 (6), P<0.001; and PACU time 45 (17) vs 70 (20), P<0.001].
Ultrasonographic-guided ISB is a cost-effective method for arthroscopic shoulder surgery.
本研究调查了超声引导下肌间沟臂丛神经阻滞（ISB）与全身麻醉（GA）用于肩关节镜手术的成本效益。
40例行肩关节镜手术的患者接受超声引导下ISB或GA。ISB在手术室（OR）外进行，患者在阻滞完成后最早20分钟被转运至OR。记录所有药物和一次性用品以评估两种技术的成本。定义了以下与麻醉相关的时间：准备手术时间（从进入OR到麻醉诱导结束）、OR苏醒时间（从包扎结束到离开OR）、麻醉控制时间（从患者进入OR到准备好体位加上从手术结束到患者从OR出院的时间）以及麻醉后监护病房（PACU）时间（从患者进入PACU到符合出院至普通病房的条件）。人员成本排除在统计分析之外。
ISB组患者的总成本为[均值（标准差）]33（9）欧元，接受GA的患者为41（7）欧元（P<0.01）。与GA组相比，ISB组的麻醉相关工作流程得到改善[准备手术时间8（3）分钟对13（5）分钟，P<0.001；OR苏醒时间4（3）分钟对10（5）分钟，P<0.001；麻醉控制时间12（4）分钟对23（6）分钟，P<0.001；PACU时间45（17）分钟对70（20）分钟，P<0.001]。
超声引导下ISB是肩关节镜手术的一种成本效益高的方法。
